tbuckley/cabot-search huggingface dataset:
POS0029 WHOLE SPINE MRI IN AXIAL PSORIATIC ARTHRITIS
Authors: S. Kawaai, S. Fukui, H. Tamaki, T. Nozaki, M. Kishimoto, M. Okada
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Psoriatic arthritis (PsA) is known to have symptoms clinically in multiple domains, one of which is the axial lesion. The ASAS classification criteria for axial spondyloarthritis include confirmation of sacroiliitis on x-ray or MRI, but there is no definition or specific imaging studies that have been determined for axial psoriatic arthritis (axPsA). <h3>Objectives</h3> This study aimed to investigate the usefulness of whole spine MRI including all spines and sacroiliac joints in patients with axPsA. <h3>Methods</h3> We retrospectively analyzed the medical records of PsA patients who were underwent whole spine MRI and diagnosed that had axial lesions. PsA was classified according to Classification Criteria for Psoriatic Arthritis (CASPAR) criteria and axPsA was diagnosed by a radiologist specializing in musculoskeletal lesions, especially spondyloarthritis. We analyzed patients' characteristics and MRI findings. <h3>Results</h3> The mean age of the 43 patients was 47.47 (±12.7) years, and 26 (60.5%) were male. The time from onset of PsA to MRI imaging was 7.98 [3.34, 18.65] years. 24 (55.8%) patients had sacroiliac joint involvement and 39 (90.7%) patients had spinal involvement. 15 (34.9%), 25 (58.1%), and 28 (65.1%) had cervical, thoracic, and lumbar spine, respectively. <h3>Conclusion</h3> In this study, about half of the patients had no MRI findings of the sacroiliac joint. On the other hand, spinal lesions were more common. Although sacroiliac joint MRI is usually performed for diagnosis in axial spondyloarthritis, imaging of the sacroiliac joints alone may be insufficient in cases of axPsA, because it is known that there are patients who do not have lesions in the sacroiliac joints but in the spine alone.(1) This study showed that whole spine MRI imaging was considered useful to avoid overlooking spinal lesions which is important for axPsA. <h3>Reference</h3> [1]Rheumatology (Oxford). 2020 Jun 1;59(6):1193-1195 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
Endoscopic resection-related colorectal strictures: risk factors, management, and long-term outcomes
Authors: Sunil Gupta, Sergei Vosko, Neal Shahidi, Timothy O’Sullivan, Oliver Cronin, Anthony Whitfield, Rajiv Kurup, Mayenaaz Sidhu, Eric Y. T. Lee, Stephen J. Williams, Nicholas G. Burgess, Michael J. Bourke
Journal: Endoscopy (2023)

Colorectal strictures related to endoscopic resection (ER) of large nonpedunculated colorectal polyps (LNPCPs) may be problematic. Data on prevalence, risk factors, and management are limited. We report a prospective study of colorectal strictures following ER and describe our approach to management.We analyzed prospectively collected data over 150 months, until June 2021, for patients who underwent ER for LNPCPs ≥ 40 mm. The ER defect size was graded as < 60 %, 60 %-89 %, or ≥ 90 % of the luminal circumference. Strictures were considered "severe" if patients experienced obstructive symptoms, "moderate" if an adult colonoscope could not pass the stenosis, or "mild" if there was resistance on successful passage. Primary outcomes included stricture prevalence, risk factors, and management.916 LNPCPs ≥ 40 mm in 916 patients were included (median age 69 years, interquartile range 61-76 years, male sex 484 [52.8 %]). The primary resection modality was endoscopic mucosal resection in 859 (93.8 %). Risk of stricture formation with an ER defect ≥ 90 %, 60 %-89 %, and < 60 % was 74.2 % (23/31), 25.0 % (22/88), and 0.8 % (6 /797), respectively. Severe strictures only occurred with ER defects ≥ 90 % (22.6 %, 7/31). Defects < 60 % conferred low risk of only mild strictures (0.8 %, 6/797). Severe strictures required earlier (median 0.9 vs. 4.9 months; P = 0.01) and more frequent (median 3 vs. 2; P = 0.02) balloon dilations than moderate strictures.Most patients with ER defects ≥ 90 % of luminal circumference developed strictures, many of which were severe and required early balloon dilation. There was minimal risk with ER defects < 60 %.
POS0054 SOCIOECONOMIC DEPRIVATION IS ASSOCIATED WITH REDUCED RESPONSE AND LOWER TREATMENT PERSISTENCE WITH ANTI-TNF THERAPIES IN PEOPLE WITH RHEUMATOID ARTHRITIS
Authors: S. S. Zhao, L. Kearsley-Fleet, K. Rogers, K. Watson, A. Bosworth, J. Galloway, S. Verstappen, J. Humphreys, A. Barton, K. Hyrich
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Recent global health crises have highlighted the importance of socioeconomic (SE) inequalities and its influence on health provision and outcomes. The impact of SE deprivation on treatment of rheumatoid arthritis (RA) is understudied in contemporary biologic-treated populations. <h3>Objectives</h3> To investigate the association between SE deprivation and outcomes of TNF inhibitor (TNFi) treatment. <h3>Methods</h3> Individuals commencing their first TNFi in the BSR Biologics Register for RA from 2001 to 2020 were included. SE deprivation was proxied using the Index of Multiple Deprivation (IMD), which measures relative deprivation of geographic areas. Using the participants' residential postcode, each individual was assigned a relative rank score and categorised into the 20% most deprived, middle 40%, and 40% least deprived; thresholds were chosen because IMD gives greater distinction within the most deprived areas. DAS28, low disease activity (LDA) and EULAR response at 6 months were compared using linear, logistic and ordinal logistic regression models with the 40% least deprived as referent. Risk of drug discontinuation was compared using Cox models. Models were first unadjusted, then adjusted for potential confounders and/or mediators, namely age, gender, baseline DAS28, BMI, HAQ, number of comorbidities, age at diagnosis, ever smoking status and rheumatoid factor status. Multiple imputation was used for missing data. <h3>Results</h3> 17,117 individuals were included (mean age 56 (SD12) years, 76% female), of whom 3002 (18%) were in the 20% most, 6999 (41%) in the middle 40%, and 7116 (41%) in the 40% least deprived groups (Table 1). The 20% most deprived group had higher DAS28 at 6 months (beta=0.30, 95%CI 0.22-0.37) and were less likely to achieve LDA (OR 0.76; 0.68-0.84) and EULAR response (OR 0.73; 0.67-0.80) in unadjusted models. They were also more likely to discontinue treatment (HR 1.19; 1.13-1.25). Adjusted estimates were broadly similar (Table 1). <h3>Conclusion</h3> SE deprivation is associated with reduced response to TNFi and increased risk of treatment discontinuation. Estimates were largely unchanged despite adjusting for potential mediators. SE inequality embodies a multitude of factors that can be intervened upon, including behaviours and biases of clinicians or institutes, which should be a focus of future research. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0014 SINGLE-CELL PERIPHERAL BLOOD ANALYSIS IDENTIFIES KEY IMMUNE SIGNATURES ASSOCIATED WITH REFRACTORY RHEUMATOID ARTHRITIS
Authors: Y. Tan, T. Bhatt, M. Sutcliffe, J. Fitton, P. Emery, A. Aslam, D. Plant, M. H. Buch
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Refractory rheumatoid arthritis (refRA) persists in the targeted therapy era with up to 20% of patients failing multiple classes of biologic (b) and/or targeted synthetic (ts) DMARDs.<sup>[1,2]</sup> Currently, there is limited understanding of the immune composition of refRA. <h3>Objectives</h3> To characterise the peripheral immune landscape of patients with refRA as compared to early RA. <h3>Methods</h3> In the Leeds observational cohort study, peripheral blood mononuclear cells were collected from 30 treatment naïve early rheumatoid arthritis (ERA) and 23 refractory rheumatoid arthritis (refRA) patients. ERA patients have &lt;12 months symptoms duration and refRA patients had active (at least moderate disease) RA despite ≥2 classes of b and/or ts DMARDs. Using a panel of 36 antibodies, we conducted mass cytometry by time of flight (CyTOF) analysis to identify alterations in peripheral immune cell subsets and functional markers between ERA and refRA, using unsupervised clustering and linear mixed-effects models, which adjusted for age, sex, seropositivity and batch. A false discovery rate of 0.05 was applied. All analyses were performed using R v4.0.2. <h3>Results</h3> The cohort had a higher proportion of females (73.3% ERA and 87% refRA) and a median age of 61 years. The majority were seropositive (86.7% ERA, 91.3% reRA). Among the refRA patients, median number of failed b/tsDMARDs was 3 (range 2-7). Overall, we identified 17 phenotypically distinct subsets from the immune cell population. ERA and refRA had similar abundance of immune cell sub-populations. However, functional marker differences in these cell subpopulations were observed between refRA and ERA: higher TNFR expression (monocytes, dendritic and FCεRI+ cells), CD80 (FCεRI+ cells), CD28 (neutrophils), granzyme B (CD4+ naïve T cells), and lower CTLA4 (monocytes), CD127 (NK cells), CD38 (basophils), NKP46 (CD8+ naïve T cells) and PD1 (CD4+ naïve T cells). <h3>Conclusion</h3> We report alteration in the functional profile across multiple immune cell types between refRA and ERA. These findings provide new insights into immunological traits of refRA and potential targets for therapy. <h3>References</h3> [1]Nagy, G. et al (2021). EULAR definition of difficult-to-treat rheumatoid arthritis. <i>Annals of the Rheumatic Diseases</i>, <i>80</i>(1), 31. [2]Roodenrijs, N. M. T. et al. (2018). Characteristics of difficult-to-treat rheumatoid arthritis: results of an international survey. <i>Annals of the Rheumatic Diseases</i>, <i>77</i>(12), 1705. <h3>Functional makers differences (refRA vs ERA)</h3> Table 1 shows functional markers expression across immune cell clusters in refRA compared to ERA, using linear mixed modelling (FDR &lt;0.05). <h3>Acknowledgements</h3> This study was supported by a UCB pharma PhD studentship (TB). <h3>Disclosure of Interests</h3> None Declared.
OP0171 ADDED VALUE OF FDG-PET/CT TO DETECT AORTIC INVOLVEMENT IN PATIENTS WITH ULTRASOUND PROVEN GIANT CELL ARTERITIS
Authors: J. Molina Collada, I. Castrejon, I. Monjo, E. Fernández-Fernández, G. Torres Ortiz, J. Martínez-Barrio, J. M. Alvaro-Gracia, E. De Miguel
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Ultrasound (US) can detect signs of large vessel (LV) involvement at axillary, subclavian and carotid arteries of giant cell arteritis (GCA) patients, but has limited access to the thoracic aorta. Although aortic involvement is not routinely evaluated in all patients with GCA, it may cause a life-threatening situation as result of serious complications such as aneurysms or dissection. <h3>Objectives</h3> Our aim is to determine the added value of performing FDG-PET/CT to detect aortitis in patients with US proven GCA and to identify factors associated with aortic involvement. <h3>Methods</h3> Retrospective observational study of patients referred to the US fast track clinics of two academic centres over a 4-years period. Only patients with US proven GCA were included for analysis. Baseline US of cranial and extracranial arteries (carotid, subclavian and axillary) was performed in all patients at diagnosis within 24-48 hours. FDG-PET/CT was performed according to clinician criteria and images were assessed by nuclear medicine physicians. An FDG artery uptake at the thoracic or abdominal aorta higher than liver uptake was defined as aortitis. Between groups comparisons were made in patients with and without aortitis. <h3>Results</h3> Seventy two patients over 186 patients with confirmed GCA by US underwent an FDG-PET/CT (mean age 77 years, 52.8% females). A total of 48 (66.7%) had LV-GCA based on imaging findings, with 29 (40.3%) presenting positive FDG-PET/CT for LV-GCA and 24 (33.3%) presenting artery uptake throughout the aorta suggestive of aortic involvement (Table 1). Only 6 (20.7%) patients had negative US findings of LV-GCA but positive FDG-PET/CT. Among patients with aortitis according to FDG-PET/CT, only 2 (8.3%) had negative US findings of LV-GCA. In contrast, 19 (45.2%) patients with US findings of LV-GCA had negative FDG-PET/CT. Patients with aortitis were younger (68.9 vs 81, p&lt;0.001), more frequently females (79.2% vs 39.6%, p=0.002) and had higher level of platelets (413.4 vs 311.1, p=0014). None of the patients with aortitis referred visual symptoms (0% vs 31.2%, p=0.001) and they presented US signs of LV-GCA more frequently (91.7% vs 41.7%, p&lt;0.001) versus patients without aortic involvement. <h3>Conclusion</h3> FDG-PET/CT can detect aortic involvement in 1 out of every 3 patients with US proven GCA. However, most of these patients show US findings of LV-GCA. In contrast, half of patients with US proven LV-GCA may have negative FDG-PET/CT. Younger and female GCA patients, with thrombocytosis, absence of visual manifestations and US pattern of LV-GCA may present more frequently aortitis by FDG-PET/CT. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
OP0261 THE NATURAL SEQUENCE IN WHICH SUBCLINICALLY INFLAMED JOINT TISSUES PROGRESS TO CLINICAL ARTHRITIS OR SUBSIDE; A STUDY ON SERIAL MRIS IN THE PLACEBO-ARM OF THE TREAT EARLIER TRIAL
Authors: D. Krijbolder, X. Matthijssen, Q. Dumoulin, B. Van Dijk, H. W. Van Steenbergen, D. Boeters, A. Willemze, A. Schouffoer, A. Van der Helm – van Mil
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Clinical arthritis is the hallmark of rheumatoid arthritis (RA), yet the trajectory in which arthritis develops at tissue-level remains elusive. <h3>Objectives</h3> We hypothesized that subclinical inflammation in different joint tissues (synovitis, tenosynovitis and osteitis) increases in a distinct temporal order in clinically suspect arthralgia (CSA) patients who develop RA, and subsides in a different sequence when CSA spontaneously resolves. <h3>Methods</h3> 185 serial MRIs from CSA-patients with subclinical joint inflammation from the placebo-arm of the TREAT EARLIER trial were studied: 52 MRIs from 21 RA-progressors (performed 1-year and 4-months before and upon RA-development) and 133 MRIs from 35 patients with spontaneous resolution of pain (MRIs at baseline, 4, 12 and 24 months). MRIs were scored for osteitis, synovitis and tenosynovitis. Cross-lagged models evaluated two types of time-patterns between pairs of inflamed tissues: a simultaneous pattern (coinciding change) and a subsequent pattern (inflammatory change in one tissue preceding change in another tissue). <h3>Results</h3> During RA-development, synovitis, tenosynovitis and osteitis increased simultaneously. Furthermore, increasing osteitis in the final 4-months before RA-diagnosis followed incrementing tenosynovitis and synovitis during 1-year to 4-months before RA-diagnosis (p&lt;0.01). Expanding osteitis occurred just before RA-development in both ACPA-positive and ACPA-negative RA. During resolution, besides simultaneous decreases, declining tenosynovitis in the first 4-months after CSA-onset preceded decreases in synovitis and osteitis during 4-12 months (p=0.02; p&lt;0.01). <h3>Conclusion</h3> Natural sequences in subclinical inflammation of different joint tissues were identified, deepening our understanding of arthritis and RA-development. During progression to RA, increasing osteitis followed previous increases in tenosynovitis/synovitis. During resolution, tenosynovitis decreased first, followed by decreasing synovitis and osteitis. Legend figure 1. Vertical arrows depict simultaneous inflammatory change in two joint tissues. Diagonal, crossing arrows depict time orders. Estimates represent the proportion of change in inflammation in two tissues that is not explained by other patterns, and are independent of scale. Higher values indicate higher explanation, and a value of 0 indicates no explanation. Statistical significant estimates are given in black with *, non-significant effects are given in grey. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
OP0242 PROPORTION OF PATIENTS REACHING THE BONE MINERAL DENSITY (BMD) SURROGATE THRESHOLD EFFECT (STE) WITH BISPHOSPHONATES, DENOSUMAB AND TERIPARATIDE
Authors: G. Adami, D. Bertelle, A. Fassio, C. Benini, D. Gatti, O. Viapiana, M. Rossini
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The bone mineral density (BMD) surrogate threshold effect (STE) is the change in BMD that can predict a fracture risk reduction with 95% certainty. The STE estimates for changes in total hip BMD have been recently validated by the FNIH-ASBMR SABRE Project. <h3>Objectives</h3> We evaluated the proportion of patients reaching the STEs with anti-osteoporotic medications in real-life. <h3>Methods</h3> We retrieved longitudinal data on women at high risk of fracture initiating an anti-osteoporotic treatment. Kaplan-Meier curves with log-rank tests were employed to analyze the proportion of patients reaching STEs over the time with various anti-osteoporotic treatments. Herein we present the proportion of patients achieving STEs for the lowest (1.8% increase in total hip BMD for all fractures, 1.4% for vertebral fractures and 3.2% for hip fractures) and highest risk reduction (5.1% increase in total hip BMD for &gt;30% risk reduction for all fractures, 4.6% for &gt;50% risk reduction for vertebral fractures and 5.8% for &gt;30% risk reduction for hip fractures). <h3>Results</h3> Baseline and follow-up data from 1,272 women initiating an anti-osteoporotic treatment were available. 807 started bisphosphonates, 386 started denosumab and 79 started teriparatide. Median follow-up time was 2.18 years (IQR 1.47-3.87 years). In Table 1 are presented the proportion of patients reaching various STEs stratified for treatment. The Kaplan-Meier estimate curve for bisphosphonates vs denosumab vs teriparatide showing the proportion of patients reaching various STEs over the time are presented in <b>figure 1</b> (log-rank p &lt;0.001 for teriparatide vs bisphosphonates at 2 years and denosumab vs bisphosphonates at 2, 4 and 6 years; log-rank p NS for teriparatide vs denosumab at 2 years). <h3>Conclusion</h3> In the present real-life study, a smaller proportion of patients treated with bisphosphonates reached the BMD STEs at 2 years of treatment as compared to denosumab and teriparatide. Nearly all subjects reached STEs at 6 years of follow-up. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Giovanni Adami Speakers bureau: Theramex, Eli-Lilly, BMS, Amgen, UCB, Fresenius Kabi, Galapagos, Davide Bertelle: None declared, Angelo Fassio: None declared, Camilla Benini: None declared, Davide Gatti: None declared, Ombretta Viapiana: None declared, Maurizio Rossini: None declared.
OP0148 ASSOCIATIONS OF CHANGES IN BODY COMPOSITION MEASUREMENTS WITH RADIOGRAPHIC PROGRESSION OF HAND OSTEOARTHRITIS: DATA FROM THE DONG-GU STUDY
Authors: D. J. Park, S. E. Choi, J. H. Kang, S. S. Lee
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Previous studies have found that obesity is a risk factor for hand osteoarthritis (OA), but most have been cross-sectional studies and thus causality is uncertain. Longitudinal studies are instead needed to explore the association between obesity-related characteristics, including fat deposition/distribution and hand OA. <h3>Objectives</h3> The present study examined the association between changes in body composition measurements and the radiographic progression of hand OA in a longitudinal cohort. <h3>Methods</h3> In the Dong-gu Study population, 1,277 patients had hand radiographs at baseline and at the 6-year follow-up. X-rays of the hand joints were scored using a semi-quantitative grading method. Body composition was simultaneously measured in a bioelectrical impedance analysis using an InBody 520 analyzer. The relationship between changes in body composition measurements and the radiographic progression of hand OA was assessed in a multiple linear regression analysis. <h3>Results</h3> Total hand joint scores increased from 16.3 ± 5.74 at baseline to 18.8 ± 8.11 at year 6 (P &lt; 0.001). Changes of body mass index, hip circumference (HC), waist-to-hip circumference (WHC), and fat mass were significantly associated with changes in the total hand joint scores (P = 0.012, P &lt; 0.001, P = 0.017, P = 0.008, respectively). HC and WHC were significantly associated with radiographic progression of the hand joints, after adjusting for age, sex, physical activity, education status, smoking, alcohol consumption, hypertension, diabetes mellitus, dyslipidemia, chronic pulmonary disease, chronic liver disease, cardiovascular disease, cerebrovascular disease, and malignancy (P &lt; 0.001, P = 0.001, respectively). <h3>Conclusion</h3> Changes in fat distribution were significantly associated with the radiographic progression of hand OA over 6 years, suggesting a role for the systemic effect of adipose tissue. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.